Provider Demographics
NPI:1518117480
Name:CAMACHO, VERONICA INES (MD)
Entity Type:Individual
Prefix:
First Name:VERONICA
Middle Name:INES
Last Name:CAMACHO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:VERONICA
Other - Middle Name:INES
Other - Last Name:CALVO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:4000 MIAMISBURG CENTERVILLE RD
Mailing Address - Street 2:STE 450
Mailing Address - City:MIAMISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45342-7615
Mailing Address - Country:US
Mailing Address - Phone:937-439-3600
Mailing Address - Fax:937-439-3786
Practice Address - Street 1:3535 SOUTHERN BLVD
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-1221
Practice Address - Country:US
Practice Address - Phone:937-439-3600
Practice Address - Fax:937-439-3786
Is Sole Proprietor?:No
Enumeration Date:2008-09-26
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.123408207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0103859Medicaid